증령적 변화로서의 두개골 봉합의 유합 상태

In order to study the closure stage of cranial sutures and its correlations with age, the ectocranial closure stage of coronal suture, sagittal suture, and lambdoidal suture of 67 skulls was measured. Among the skulls kept at the department of anatomy, college of medicine, Yonsei University, the ones with ages identified were used for this study. These measurements of suture closure were conducted by 4 examiners independently. The sutures were further divided by Frederic's method into 16 suture parts. The closure stages were classified by five stages of Broca-Ribbe. The following results were obtained: 1. The inter-observer reliability among 4 examiners showed high intraclass correlation coefficient of over 0.75(mean : 0.856) in all suture parts. Therefore, the determination of closure stage wasn’t influenced by the subjective view of each examiner. 2. In all suture parts, the closure stage increased proportionally with age.(p<0.01) In terms of each suture part, the S2 part of sagittal suture showed the highest correlation(68.1%) while the L1-R part of lambdoidal suture showed the lowest correlation(51.3%). In addition, in terms of suture types, the correlation with age decreased in the order of sagittal suture(60.0%), coronal suture(57.7%), and lambdoidal suture (55.7%). In general, the average value of suture closure stages had 57.8% correlation with age(p<0.01). 3. The most frequent suture closure stage according to age group was ‘0’ for ages below 30, ‘0’ and ‘1’ for ages within the 30’s, ‘1’ and ‘2’ for ages within the 40’s, and ‘2’ for ages within the 50’s. With older age groups, the frequency of ‘3’ and ‘4’ increased, and the suture closure stage increased proportionally with age. 4. The mean age by closure stage of each suture were within the 40’s for the closure stage of ‘1’, within the 50’s for the closure stage of ‘2’, and from 50’s through 60’s for the closure stage of ‘3’. The standard deviation was over 10 for all closure stages. In addition, at the same suture closure stage, the mean age according to the coronal suture was higher than the ages according to the sagittal suture or lambdoidal suture. Especially, C1-R, C1-L, C2-R, and C2-L parts showed the highest age when at the same suture closure stage. 5. The values appropriate for age estimations using suture closure stages of 16 suture parts were calculated, and a calculator for age estimation (R2=0.6944, p<0.01) by ectocranial suture closure stage for Koreans is presented. From the above results, the method of using the closure stage of sutures of the skull to estimate age can be useful in individual identification of forensic science. Further extensive and accurate research using larger samples would be worthy of study.ope

The Use of Salivary Gland Scintigraphy for Diagnosis of Primary Sjögren Syndrome and Thyroid Disease in Patients with Dry Mouth

Sjögren syndrome (SS) is a chronic autoimmune disease characterized by dryness of the mouth and eyes due to lymphocytic infiltration of the exocrine glands. In American European Consensus Group (AECG) criteria, abnormal salivary gland scintigraphy (SGS) result is one of the objective signs of SS and it has been proposed as a valid and non-invasive alternative approach to functional evaluation of salivary gland, especially in the case when unstimulated whole salivary flow is more than 1.5 mL in 15 minutes or other AECG criteria is unmet. Patients with SS are more likely to have the thyroid disease (TD), but this association remains controversial. We present a case of the use of SGS for diagnosis of primary SS and TD in patients with dry mouth and burning sensation of tongue. Through this case, we suggest the usefulness of salivary scintigraphy for screening TD in addition to diagnosis of SS.ope

Vestibular Schwannoma Presenting with Orofacial Dysesthesia: A Case Report

Vestibular schwannoma, also known as acoustic neuroma, is a rare benign brainstem tumor surrounding the vestibular division of the 8th cranial nerve. The presenting symptoms are hearing loss, tinnitus, and dizziness. Unabated growth can compress 5th (trigeminal nerve) and 7th (facial nerve) cranial nerve, which can cause nerve dysfunction such as orofacial pain, sensory abnormalities, or trigeminal neuralgia. We report a 51-year-old woman who presented with orofacial dysesthesia on her left side of the face with abnormal findings on 5th cranial nerve and 8th (vestibulocochlear nerve) cranial nerve examination. Brain magnetic resonance imaging scan revealed cerebellopontine angle tumor. She was referred to a neurosurgeon and diagnosed with vestibular schwannoma.ope

Oral manifestation of paraneoplastic pemphigus

Paraneoplastic pemphigus (PNP) is a rare and often fatal autoimmune blistering disease accompanied by both benign and malignant neoplasms. Usually, oral, skin, and mucosal lesions are the earliest manifestations shown by PNP patients. Oral ulcers are initial lesions in various autoimmune diseases like pemphigus, bullous pemphigoid, erythema multiforme, graft-versus-host, lichen planus, it does not improved despite of high-dose steroid therapy. We report a-35-year-old female who presented oral ulceration, lip crust and skin lesions. By doing several examinations, such as enzyme-linked immunosorbent assay, incisional biopsy with indirect immunofluorescence, she was diagnosed PNP with non-Hodgkin’s lymphoma on pancreas.ope

An Analysis of the Temporomandibular Joint Range of Motion and Related Factors in Children and Adolescents

This study was designed to establish safe guidelines for pediatric dental practice regarding temporomandibular joint (TMJ) range of motion (ROM) and mouth area (MA). A total of 438 children aged 3-15 years old of homogenous ethnicity participated in the study; the distribution of participants was approximately equal (sex; n = 15; age, n = 30). Maximum mouth opening (MMO), body height, weight, and age of each participant were recorded, and the TMJ ROM including anterior and lateral movements, MA, and mouth width were documented. Males showed higher mouth width, MMO, and MA values than females. MMO and MA increased with age, height, and weight in a statistically significant manner. MMO of 40 mm is reached by the age of 5.2 years, at a height of 105.9 cm and a weight of 18.6 kg. MMO showed a moderate correlation with age, height, weight, and mouth width, and MA moderately correlated with mouth width. Anterior and lateral movements did not show any close relation to these aforementioned factors. The findings of this study suggest that forcible mouth opening over 40 mm should be more cautiously considered, especially in children shorter than 105 cm, lighter than 18 kg and in children under 5 years old.ope

A Study on the Effect of Media Education in Patients with Temporomandibular Joint Disorders

Purpose: The first-line treatment of temporomandibular joint disorders (TMDs) should include self-management and education. Self-management techniques include moist heat application, stretching, diet control, and mandibular rest position adjustment. Although the effectiveness of video educational resources has been studied in multiple sectors, their application in TMD management has not yet been explored. This study seeks to assess how effective media education was at motivating TMD patients to self-management and improve symptoms. Methods: Data were obtained from the hospital records of TMD patients who visited the Department of Oral Medicine, Yonsei University Dental Hospital, between May 2020 and December 2021. First, without any differences between groups, a significance analysis was conducted between the degree of self-management and symptom improvement over time. At the second visit, one group received media education (n=31) linked to TMD management, while the other received written-oriented education (n=45). At the third visit, the number of precautions taken by the patients was determined and contrasted to that recorded in the previous visit between the groups. Generalized estimated equation multivariate models were applied for statistical analysis. Results: In the media education group, the frequency of stretching and the number of patients on pain-free diets increased substantially. Taking precautions improved daily pain intensity, maximum mouth opening, and pain intensity during the maximum unassisted opening. Conclusions: Media education could be beneficial for TMD patients because it allows them to take self-management precautions. The symptoms of the media education group improved, with no considerable distinction between both groups.ope

Methotrexate-induced Oral Mucositis

Methotrexate (MTX) is a chemotherapeutic agent that is used to treat a host of malignancies. But recently, MTX has also been used as a therapeutic agent for chronic inflammatory disorders such as rheumatoid arthritis, psoriasis, and systemic lupus erythematosus. However, MTX is an antimetabolite that affects rapidly dividing normal cells such as oral mucosal epithelial cells, gastrointestinal epithelial cells, and bone marrow cells?which explains why oral mucositis is often an initial manifestation of MTX toxicity. Because oral lesions are frequently initially presented in dental clinics, dentists should consider the possibility of adverse drug reactions in the differential diagnoses of oral lesions through a meticulous collection of patients’ medical histories. In this report, we examine patients who suffered from oral ulcerative lesions upon diagnosis of MTX-induced oral mucositis. Then, we suggest approaches for the diagnosis and treatment of MTX-induced oral mucositis through a review of literature.ope

The Effect of Dilution with 10% Dextrose Solution on the Potency of Botulinum Toxin A

Purpose: The aim of this study was to compare the potency-stabilizing effects of two different diluents of botulinum toxin A (10% dextrose solution and 0.9% saline). Methods: A mouse lethality bioassay was undertaken. Ninety mice were divided into experimental and control groups which received varying dosages in subgroups of 10. The experimental group was injected with botulinum toxin A diluted with 10% dextrose solution and the control group was injected with botulinum toxin A diluted with 0.9% saline. A 72 hours after intraperitoneal injection, the number of dead mice was counted to confirm median lethal dose (LD50) of each group. Results: The value of LD50 in the experimental group was approximately 0.131 mL (1.31 U) and the value of LD50 in the control group was approximately 0.107 mL (1.07 U). The potency preservation rate of the experimental group was estimated to be 93.5% and that of the control group was estimated to be 76.3%. Conclusions: Dilution with 10% dextrose solution displayed less potency loss than 0.9% saline.ope

The Characteristics of Sleep in Headache Patients

Purpose: To investigate the relationship between headache and sleep by evaluating sleep quality, daytime sleepiness, and specific features related to sleep-disordered breathing (SDB). Methods: One hundred one subjects with headache and 118 healthy controls were enrolled. To collect various information on headache attacks, headache group completed self-reported questionnaire about the characteristics of headache attacks and the migraine disability assessment (MIDAS) questionnaire. The subjective quality of sleep was evaluated in all of the subjects using the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). In addition, the following specific features of sleep were evaluated in 28 subjects selected randomly from each group: apnea-hypopnea index (AHI), prevalence of SDB, nocturnal oxygen saturation (SaO₂), and oxygen desaturation index (ODI) as measured using a portable monitoring device. Results: The global PSQI and the prevalence of poor sleeping (global PSQI ＞5), ESS scores and the prevalence of daytime sleepiness (ESS score ＞10) were significantly higher in the headache group (both p＜0.0001, respectively). The mean scores on the numerical rating scale and the MIDAS were significantly higher in the poor-sleeper group than in the good-sleeper group (p=0.0347 and p=0.0016, respectively). The global PQSI and prevalence of daytime sleepiness were significantly higher in the chronic-headache group than in the acute-headache group (p=0.0003 and p=0.0312, respectively). Conclusions: There is a significant association between headache and sleep. Especially, severity and chronicity of headache were significantly associated with sleep quality and daytime sleepiness.ope

Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.ope